ABSTRACT: Cardiovascular dysfunction is common in severe sepsis or septic shock. Although functional alterations are often described, the elevated serum levels of cardiac proteins and autopsy findings of myocardial immune cell infiltration, edema and damaged mitochondria suggest that structural changes to the heart during severe sepsis and septic shock may occur and may contribute to cardiac dysfunction. We explored the available literature on structural (vs functional) cardiac alterations during experimental and human endotoxaemia and/or sepsis. Limited data suggests that the structural changes could be prevented and myocardial function improved by (pre-) treatment with platelet activating factor (PAF), ciclosporin A (CsA), glutamine, caffeine, simvastatin or caspase inhibitors.